Treat physician burnout by seeing more patients

Physician burnout is inevitable in today’s healthcare environment. A recent study shows that physician burnout jumped from 45 to 54 percent between 2011 and 2014. Researchers identified contributing factors as growing administrative burdens, rising operating costs, and increasing patient demands for frontline care.

As a resident in otolaryngology head and neck surgery, I have already begun to feel the brunt of these challenges. Young physicians aren’t imperviable to burnout. If anything, we are even more susceptible to it because of the grueling hours we put in each week with clinical responsibilities, educational commitments, and being on call. That’s not counting our mounting medical school debt, on average $190,000.

For me, finding the time and space to reset and remind myself of why I became a doctor in the first place has been the perfect antidote to burnout. I have always enjoyed physical activity, but I was surprised to find that the most transformative experiences have not come from exercise or a vacation. Rather, the best form of self-care has been through participation in international medical missions.

Poor quality or limited healthcare in low- and middle-income countries results in millions of deaths and health complications each year, which is why I have found these trips to be so invigorating and humbling.

As an otolaryngologist, I have specialty training in medical and surgical management of cleft lip and palate deformities. In addition to the aesthetic concerns and associated stigma, cleft lip and palate deformities leave children with significant physical challenges, including impairment in speech production, swallowing mechanics, and predisposition to recurrent ear infections. Performing cleft lip and palate surgery is extremely fulfilling because the child’s life is forever changed, and the profound impact is immediately visible.

One in every 700 babies worldwide are born with an oral cleft. In the United States, children with cleft palates typically undergo corrective surgery within the first twelve months of their life. But across the world, where more than half of the population doesn’t have access to basic healthcare, thousands of children do not receive corrective surgery interventions.

During my most recent medical mission to Ica, Peru, our team screened roughly 120 pediatric patients, some who travelled up to 24 hours by horse and bus, to determine appropriate candidates for primary and revision cleft lip and palate surgery. A large percentage of these patients come from the Amazonas region in northern Peru where many had never been examined by a physician, let alone a specialist surgeon. We were able to complete 75 operations for these weary travelers in just one week, including 18 primary cleft lip repairs, 29 cleft palate repairs, four frenuloplasties, three cleft rhinoplasties, two first stage microtia repairs, and one second stage microtia repair for a follow-up patient whom the group previously treated.

Despite long hours of travel and the time it takes to organize an international medical mission and team of volunteers, I believe these trips are invaluable, both for the patients as well as the physicians. These complex reconstructions can take between one to three hours in the operating room. Afterward, the child immediately experiences an improvement in his/her articulation and swallowing mechanics. Perhaps the biggest reward is seeing the relief and gratitude in the parents’ eyes when their child is returned to them with a repaired facial deformity.

Unfortunately, international medical missions can pose a significant financial burden on a resident’s salary. While it is dependent on specialty and region, the average resident's salary in 2018 was $59,300.

Fortunately, my most recent medical mission to Ica, Peru, was partially funded by the Dox Foundation, which provides grants for its members to complete medical missions in underserved communities worldwide. I have found foundations along with other resources, such as the American Academy of Otolaryngology-Head and Neck Surgery and the American Academy of Facial Plastic and Reconstructive Surgery, that help physicians defray the cost of providing care to underserved communities. It is encouraging to know that there is not only a community of support, but nonprofit organizations that can financially assist physicians.

Fighting burnout through regular international medical missions may not be a viable solution for all physicians, but finding a way to take a step back is possible. Whether that is in the form of a rest and decompress or mental health day or attending a weekend yoga retreat, I urge my fellow physicians to create that space for themselves.

I also urge healthcare leadership to offer the flexibility for physicians and other healthcare providers to seek out creative ways to address burnout. Beyond offering employee benefits and organizational support, clinical leaders should also do what they can to foster a culture that recognizes and addresses burnout when it happens. After all, physicians are humans, and we need care, too.

I'm sincerely grateful for the opportunity to partake in a humanitarian mission that allowed me to remove myself from my routine and temporarily break free from daily stressors. Giving these children the ability to form a normal smile puts everything back into perspective. It helps me reclaim my calling and become reacquainted with my passion for medicine. This mission changed my perspective on my profession. 

Sean Alemi, MD, is an otolaryngologist in Great Neck, N.Y., and is affiliated with multiple hospitals in the area, including North Shore University Hospital and St. Francis Hospital.